The Natural Prozac

On a fall afternoon in the mid-’80s, I sat on the tweed sofa in my psychiatrist’s office, two years after entering therapy, feeling as depressed as I’d ever felt in my life, as she told me that I was one of those people who would always have empty pockets. What she meant, I assumed, was that my depression would forever interfere with my ability to feel fulfilled. What I heard was a life-sentence—I was a depressive.

Then, in 1989, I went to Kripalu Center for Yoga and Health in Lenox, Massachusetts. Though I’d been meditating irregularly since 1970, it was there that I took my first yoga class. The language of the class seemed familiar to me from a brief stint in cognitive therapy. If I could change the way I thought about myself and my life to thinking I wasn’t a depressive but a person who sometimes felt depressed, my feelings would follow. In class, we were encouraged to listen to the wisdom of our bodies and to simply be aware of the sensations we felt as we moved into, held, and released an asana. So simple. So radically life-changing. Physically, I felt like Rip Van Winkle, waking up, in my case, after nearly 40 years of sleep.

What was this miracle taking place? I had always been an exercise nut. Why was this particular form of exercise not only making me feel better but changing my life? Within a year, I was no longer taking antidepressants. Six months after that, I was sitting in a workshop, in which the leader asked us to name ourselves. I closed my eyes and without hesitation, named myself “Abundance.” What happened to those “always empty pockets?” I still had sad feelings from time to time, but the kind of mind-numbing depression that prevented me from properly putting two shoes in a shoe box or remembering how to fold a bridge chair was now just a story I could tell about how I used to be. If yoga worked so well for me, why weren’t shrinks across the nation prescribing it to the millions they were putting on Prozac and other antidepressants, costing Americans $44 billion annually?

There are billions to be made by the pharmaceutical industry with the promotion of the concept that what ails us is our brain chemistry, and if we take a pill, we’ll be okay. Actually, for some of us, this may be true. A pill like Prozac or one of the other selective serotonin re-uptake inhibitors (SSRIs) can increase the amount of serotonin in our brains, and we may feel better.

But what’s wrong with this picture? Why are so many of us allegedly serotonin deficient? Research with rhesus monkeys has clearly demonstrated that early trauma, such as separation from the mother, actually changes brain chemistry. Studies have also shown that stress itself, including the stress of social separation, affects the balance of serotonin in the brain. Could it be that the stressors inherent in our modern culture are the source of an international serotonin deficiency, causing depression in epidemic proportions? “Many of us, it seems, at the fin de siËcle, live deeply disconnected from our well-springs of meaning and purpose, our vitality and authenticity,” says psychotherapist and yogi Stephen Cope, author of the book Yoga and the Quest for the True Self (Bantam, 1999). Certainly, our postmodern culture has created a widespread emotional impoverishment. Since World War II, depression and suicide among adolescents has more than tripled. Even more startling evidence of our suffering is found in a study published in 1994, which determined that among people between the ages of 18 and 54, nearly half had suffered from a serious psychiatric illness.

Source of Suffering

Because of the stressful human and technological complexities of our age, we often assume that ours are the worst of times. But human beings have always suffered. “Living in the mortal body,” the Buddha said, “is like living in a house on fire.” In the yogic view, the source of our suffering is our ignorance—avidya. We have forgotten who we are. We create an identity out of what we do, who and what we love, how much money we make, and the things we surround ourselves with. From the classical yogic perspective, we are inviting disappointment, if not depression, into our lives because we have created an identity based on the five kleshas, or “afflictions”—ignorance, egoism, attachment, aversion, and the will to live—that keep us bound to gross apparent reality.

Cope says that much of our modern angst has arisen from our inability to soothe ourselves, because many of us have not been given enough of the soothing experience of being safely and securely held as children. If early trauma can disturb our brain chemistry, could it be that healing experiences in psychotherapy and on the yoga mat can actually balance the chemistry disturbed by such trauma? Many psychotherapists and yogis believe that it can. Or, if some of them prefer not to talk in biochemical terms, they do feel that yoga works well with people who suffer from depression. Perhaps the most convincing stories come from practitioners themselves, who feel that yoga gave them back their lives.

Take Tracy, for example, a 27-year-old yoga student in Cleveland whose depression began with an emotional trauma, the loss of her mother when she was 15. Since beginning to practice yoga in 1995, she says, “I see that my depressions have a purpose, and that the downs are sometimes rest periods from my constant struggles.” Or Ram, who was doing heroin with his girlfriend Debie in the early ’90s when the cancer that killed her was discovered. In desperation and grief, he went to his first yoga class, and after two months of regular practice, he was able to get himself clean and “for the first time…saw things as if I had been blind all my life.” Ram is now a yoga teacher in West Palm Beach, Florida.

Or Penny Smith, a yoga teacher in Harleysville, Pennsylvania, whose depression is clearly biochemical. She, like a number of family members, has bipolar disorder and has cycled between mania and depression all her life. After her last hospitalization eight years ago when her doctors told her that she could expect to be in and out of hospitals for the rest of her life, she began to practice yoga. With the practice of Pranayama, says Smith, “I was able to eliminate panic attacks completely.” Now, during her depressive episodes when she awakens at 3 a.m., the repetition of mantras and deep yogic breathing help her to fall back to sleep. Her pattern of severe depression and manic episodes has tempered into mild depression, and she has not been hospitalized. Yoga changed Smith’s life. “Without it,” she says, “I might not be alive today.”

Grief in the Tissues

International yoga teacher and clinical psychologist Richard Miller, founding editor of the Journal of the International Association of Yoga Therapists, says that most people he treats for depression have the belief that “I should be other than I am.” The first step is to help people see how that belief manifests in their lives—in their thoughts, their breathing, and in their bodies. For example, a yoga teacher who was seeing Miller for the treatment of depression began, at his suggestion, to keep a daily journal where she could see her judging thoughts about herself.

During a therapy session, he asked her to do an asana. “She immediately saw that her interest in the posture was ‘Am I doing it right?’ So we now had a body-based knowledge of this on-going, chronic belief.”

Initially, the emphasis in Richard Miller’s approach with a depressed patient is to help him see what he is accepting and what he is not accepting in his life. Then, the emphasis shifts to the nature of acceptance itself. Sometimes, according to Miller, when we accept something we’ve been judging as bad or wrong, we’re merely “rearranging the furniture.” To get at the root of the problem and prevent the depression from returning, we need to see that our basic nature is “free of judgment, open, and clear-seeing.” Through the cultivation of such vision, Miller encourages people to understand that they are not their emotions. He helps a depressed person see that “I’m not sad, but sadness is present in my awareness.”

The kind of nonjudging self-acceptance that we talk about in yoga class and in various kinds of psychotherapies—what yogis have called “equanimity”—can be challenging but ultimately redemptive for a depressed person. In addition, according to Miller, depression is a somatic-based problem that has gotten into the tissues, and people who are depressed need bodywork. “Yoga is an exquisite form of bodywork that eliminates the residue that has become lodged in the tissue.” The yogic view is that the samskaras (impressions left from emotional or physical trauma) are primarily retained in the subtle bodies and are subsequently reflected through physical symptoms of tension in the gross bodies. “Yoga postures can penetrate what Wilhem Reich, the founder of the science of bioenergetics, called ‘character armor,’ our unconsciously held patterns of physical contractions and defenses,” says Cope in Yoga and the Quest.

But yoga teachers differ over the use of asanas in treating depression, and the source of that difference seems to be whether you believe the yoga mat is the appropriate place for working with the emotions. Some teachers take a “the only way out is through” approach that allows and even encourages the darker emotions to surface on the mat. Such teachers might guide a student into staying present with the emotions that arise in slow, deliberate movements and in longer holdings of postures. Other teachers assume the mat is the place where a student emerges from the darker emotions and begins to feel relief. These teachers might recommend a vigorous practice and discourage postures that could promote brooding, like seated forward bends and Savasana (Corpse Pose).

International yoga teacher-trainer and student of B.K.S. Iyengar, Patricia Walden, takes the second approach. Her classes are designed so that people leave feeling less depressed. For people suffering from a depression characterized by inertia and fatigue, or who are going through a period of loss, Walden recommends a practice of supported backbends and inversions. For those who experience depression with anxiety, she recommends a more active sequence of postures, modified according to experience and physical energy level, to keep them “out of themselves.” The energetic postures she recommends include Sun Salutations, backbends, and inversions.

Inverted postures are particularly useful because they alter the blood flow, including lymphatic drainage and cranial sacral fluid, according to Dr. Karen Koffler, an internist who trained with Andrew Weil in the Integrative Medicine Program at the University of Arizona. “If there is increased blood flow to the area, there will be increased bioavailability of oxygen and glucose—the two most important metabolic substrates for the brain. It follows, then, that those cells bathed in a solution that is rich in the building blocks required for the creation of neurotransmitters like norepinephrine, dopamine, and serotonin, will be better able to produce these chemicals.” In nonmedical terms, then, as we practice yoga, we may literally be feeding our brain with a healthy dose of our own self-generated neurotransmitters.

Walden tells her depressed students to keep their eyes open wide, and if they are brooding, she guides them from posture to posture without pausing in between, to generate life force and focus the mind on the body. Because people who are depressed are often shallow breathers, she encourages strong inhalations. And at the end of a practice, she suggests a brief cool down, with a pose like Setu Bandha (Bridge Pose) to elevate and open the chest.

Though Richard Miller doubts that you can prescribe specific asanas across the board for people with depression, he agrees that trying certain postures on an individual basis is a way to start. In his own work with depressed students, he might suggest several poses, then carefully observe the person in the posture. As he watches, he might see that a person’s energy is blocked in areas of self-expression—perhaps the chin is tucked and the throat seems constricted. Here, he might guide the student through an asana that opens the vishuddha chakra. Or if he notices that energy is blocked around the heart, he might do heart-opening postures involving anahata chakra. Since low self-esteem often accompanies depression, postures that energize the solar plexus at manipura chakra might help. “The important thing,” says Miller, “is to watch how the energy moves in the body. You might find the energy moving from the throat down to the heart because there’s sadness that the person has been living in a false self and hasn’t been expressing the true spirit inside.”

For Stephen Cope, it’s not the asana itself that’s important, but the quality of attention we bring to it that can make a difference for someone who’s depressed. “Slow, deliberate movement anchors the mind in sensation and allows a deep relearning to happen.” The practice of postures is intentionally meant to create the physiological foundation for the “steadiness and relaxation” of which Patanjali spoke 2,000 years ago.

From the Viniyoga perspective, depression is an energetic condition in which tamasic (meaning dark or sluggish) qualities of mind and emotions prevail, says Gary Kraftsow, founder and director of the American Viniyoga Institute, and author of the book, Yoga for Wellness: Healing with the Timeless Teachings of Viniyoga (Penguin, 1999). The <a href="/health/ayurveda“>Ayurvedic tradition provides the two governing concepts of Viniyoga therapeutic treatment. The first is langhana, embodying techniques that reduce, eliminate, calm, and purify. The second is brahmana, referring to techniques that nourish, build, tonify, and energize. So, for example, a person with depression characterized by lethargy may benefit from postures that are more brahmana, like Virabhadrasana (Warrior Pose) or Tadasana (Mountain Pose). But Kraftsow reminds us that each individual is unique and that all techniques should be adapted to the needs of the individual body’s structure. For example, he says that though many people with depression have a rounded upper back and sunken chest, there are those whose upper backs are flat, so the postures that address the structural needs of that person might be different from those that work best for someone whose spine curves forward, though both individuals may be depressed. “Viniyoga’s view is that the job of the teacher is to provide the appropriate method for the student and not be fixated on one modality.”

In treating a person with depression, Kraftsow tries to meet the person where he is and to pace the yoga session accordingly. With someone who has little motivation to move, he starts progressively. He may start with the person lying on his back, then move toward more vigorous standing postures. Vigorous standing postures might be beneficial for someone who feels too lethargic to exercise, “but first you have to have a strategy for getting them off the couch. The best strategy may not be asanas, but simply inviting them out for a walk.” In my own experience, when I’m feeling that lethargic, even a walk takes more energy than I can muster. So what do you do if you don’t feel like practicing? Sometimes I play an audiotape and let another teacher lead my practice. And there are days when simply stepping outside my back door and raising my arms can lead me into strong, vigorous breathing and a pranayama practice. But occasionally, none of this works. Those are the times when Richard Miller says, “let the yoga come to you.” He recommends taking one pose, or even half a pose, and doing it slowly and with great attention so that, for instance, your right arm “feels wonderfully delicious, and then perhaps you’ll want your other arm to feel that way, and your leg and the other leg.” At these times, it’s especially beneficial “to empty out the feeling of needing to do it right, to let go of rigidity and to practice so you really enjoy doing it.” When self-judgment comes up in yoga, simply observe it. Miller says it’s part of the eliminative process and is to be expected as we become aware of our old ways of thinking.

Pumping Prana

When Penny Smith eliminated her panic attacks through yogic breathing exercises, she was tapping into thousands of years of yogic wisdom. “Yogis understood,” says Stephen Cope, “that even in the absence of immediate stressors, ‘disturbed breathing’ (thoracic breath) could perpetuate or re-create a state of sympathetic nervous system arousal, causing anxiety states, panic, and fear reactions.” Thousands of years ago, yogis designed a system of deep abdominal-diaphragmatic breathing that relaxes the body and calms the mind.

In his experience working with patients at a mental health facility in Phoenix, yoga teacher Ted Srinathadas Czukor says that the most effective tool was pranayama. In one case, a 340-pound woman with numerous physical and emotional disabilities, who was often subject to panic attacks, usually had to be sedated before routine medical treatment. After a few months of practicing deep diaphragmatic breathing with Ted, a new note was added to her medical chart: “Before you begin your procedure, give her five minutes to do her yoga breathing. No medication will be necessary.”

Several new studies done under the auspices of the National Institute of Mental Health and Neurosciences in India have concluded that a particular practice called Sudarshan Kriya, taught in this country as The Healing Breath Technique by the Art of Living Foundation, has remarkable therapeutic effects—a 68 to 73 percent success rate in treating people suffering from depression, regardless of the severity. According to Sri Sri Ravi Shankar, an Indian spiritual teacher who has revived the ancient technique, the root cause of depression is a low level of prana in the system. The Healing Breath Technique is a purifying practice that involves breathing naturally through the nose, with the mouth closed, in three distinct rhythms, “flooding every cell of the body with both oxygen and prana, eliminating physical and emotional toxins at the cellular level,” says Ronnie Newman, a Harvard-trained researcher in nontraditional therapies and Research Director for the Art of Living Foundation.

What Comes Up

In 1990, when Jon Kabat-Zinn published Full Catastrophe Living (Bantam Doubleday Dell, 1990) the general public learned of a system of stress reduction that he and his colleagues developed at the University of Massachusetts. The Stress Reduction and Relaxation Program (SR&RP), which has now been taught to more than 7,000 people, includes a 45-minute hatha yoga component, but its primary tool is mindfulness meditation. In study after study, the SR&RP has shown a measurable reduction in depression and anxiety. A recent yearlong study that involved 145 people in three separate countries, all of whom were at risk of a recurrence of depression, showed that those who participated in the SR&RP in combination with group cognitive therapy had a significantly lower rate of relapse than the control group. According to Zindel Segal, Ph.D., coauthor of the study, people were trained to follow their breath, to become aware of their thinking, and to step back and observe their thinking without reacting. Asanas were used to get the energy flowing and to move awareness into the body. The program incorporated slow stretching, directing the students to become aware of “what comes up.” Segal echoes Richard Miller when he says “getting people to consider depression as a state of mind, of rising and falling mood, is more useful to them than to think of themselves as depressives.”

Despite the evidence gleaned in a multitude of studies in Canada, Wales, England, and the United States that a mindfulness-based meditation technique, combined with hatha yoga and diet, is beneficial in treating depression and preventing relapse, many practitioners say they cannot meditate when they feel depressed. For people suffering from severe depression, sitting in stillness and watching what comes up can become unbearable. On the other hand, some meditation techniques may work especially well when one is feeling depressed. For someone who has depression accompanied by low self-esteem and self-critical thinking, Gary Kraftsow recommends a technique in which the meditator focuses on his own positive qualities, what a psychologist might call cognitive reframing.

Hatha yoga is more accessible than meditation for most Westerners as a way of learning self-soothing, says Cope. “First of all, it is absolutely impossible to be obsessing about anything when you’re fully in your body. The mat becomes a kind of external anchor for the self.” A yoga practitioner can have “a regular, systematic experience of well-being and sense that everything is absolutely okay, and that I am absolutely okay. This can be very self-building, especially when done in the context of relationship with a class and teacher.”

In fact, says Cope, many of our depressions are caused by a breakdown in relationship in our early years. We simply didn’t get enough of that holding and soothing that a loving relationship provides. In the teacher/student connection, yoga can provide a mode of healing through relationship. “The contemplative traditions,” says Cope, “share two fundamental premises with the world of Western psychotherapy: That which is damaged in relationship must also be healed in relationship, and character can only truly be transformed through relationship, not through solitary practice.”

The language used by the teacher in a yoga class can help create that “relational container” psychologists talk about. Language also has the capacity to help students reframe their experience and move away from depressive thoughts. Rubin Naiman, Ph.D., a health psychologist and yoga practitioner in Tucson, Arizona, talks about how his yoga teacher gently and repeatedly encouraged him to do what he could until he found he was assuming postures he previously “knew” he couldn’t. “I broke the frame of my old beliefs through encouragement and small steps. This parallels cognitive approaches for treating depression.”

According to Shauna Shapiro, M.A., a doctoral student in clinical health psychology at the University of Arizona and coauthor of several recent mindfulness studies, the language a teacher uses in class “creates the intention behind the yoga practice,” and our intentions play a crucial role in our well-being.

A Sacred Circle

When we’re feeling depressed, we long for genuine connections with others who accept us as we are, and we often can find that in a yoga class. Richard Miller thinks that the ideal class for someone coping with depression would provide an opportunity for folks to share their stories in a nonjudgmental atmosphere. In her daily classes at her center in Rhode Island and on her retreats in Mexico, yoga teacher M.J. Bindu Delekta creates a “Sacred Circle” where such sharing is possible. Bindu Delekta might ask the circle of students, “How are your bodies feeling today?” Then she lets the energy of the sharing determine how the class will move, which she believes is more important than going through a prescribed sequence of postures. She fosters the relational community that the students are building for themselves with their sharings by using partner postures. The students build a community of trust as they learn to assist each other, touching and being touched in the process.

Phoenix Rising Yoga Therapy takes just such a relational approach in working one-to-one with a client. “I think it’s vital for the client/therapist relationship to be one that empowers the client rather than one that creates dependency,” says PRYT founder Michael Lee, M.A., author of Phoenix Rising Yoga Therapy—A Bridge from Body to Soul (Health Communications Inc., 1997). Through a dialogue between client and therapist, the Phoenix Rising process seeks to put words to the observations of self that emerge in the conscious holding of a posture. “The loving and nonjudgmental presence of the practitioner” creates a “sanctuary” for such observations. The client can then begin to “witness, acknowledge, accept, and connect” these self-observations to daily life. As clients “dialogue around the experiences” with a therapist, they may identify core beliefs that support a depressed state of being. “In the integration phase of the work,” says Lee, “the client may make new life choices that support a less depressed state.”

Whether we practice alone, with a yoga therapist, or in a room full of like-hearted, like-minded people, establishing a daily practice of yoga creates a sense of everyday sacredness. It becomes a personal ritual in which we come home to our bodies, home to what is true for us that day, which may include depression and anxiety. But filtered through the lens of our practice, we can see ourselves more clearly, and as research indicates, the depressed mood often becomes less intense.

Accepting What Is

Krishna, in the Bhagavad Gita, didn’t have Western medical science to back him up when he counseled Arjuna that he could do his duty and fight his clansmen without accruing karma if he let go of the fruits of his actions as he went into battle. But the evidence is in. Joel Robertson, in Natural Prozac, tells us that “the more personally invested you are in winning, the lower your serotonin levels will be when you lose and the higher they’ll be when you win.” Indeed, when we attach ourselves to the outcome of our actions, we may be having a negative effect on our brain chemistry. So we now have a biochemical reason to practice acceptance and nonattachment.

In his chapter on depression, Thomas Moore, author of Care of the Soul (HarperCollins, 1992), among other best-selling books on spiritual psychology, asks the following question: “What if ‘depression’ were simply a state of being, neither good nor bad, something the soul does in its own good time and for its own good reasons?” If we can maintain our practice during these times of melancholy, there is evidence that we may be balancing brain chemistry in ways that make depression tolerable. We may not cure the depression with our practice, but we may begin to accept these times in our lives and be able to grow from “the gifts of soul that only depression can provide.”

“Depression may be exhilaration waiting to happen,” says Michael Lee. That’s certainly true if you’re a bipolar manic depressive. But when you’re in a depressed state, whatever its source, if you don’t have some kind of spiritual practice, it’s hard to remember that “this, too, shall pass.” I couldn’t imagine exhilaration when I was on antidepressants and in treatment for depression in the mid-’80s. But now, after 10 years of daily yoga practice, when I feel depressed, I am capable of remembering that everything changes. I have developed as Thomas Moore suggests, “a positive respect” for depression’s “place in [my] soul’s cycle.”

The poet, translator, and teacher Jane Hirshfield, herself a long-time Zen practitioner, often writes of her own strategies for coping with her “days of the black dog.” At the end of her poem “The Door” in her collection October Palace, she expresses a way in which we might embrace depression:

The rest note,

unwritten,

hinged between worlds,

that precedes change and allows it.

In my own journey, I have come to the place where I can integrate and accept my darker moods, to allow them to teach me what I need to learn about myself this time around. Now when I have insomnia and feel lethargic and overwhelmed, symptoms I recognize in myself as depression, what I seek is something steadier than exhilaration. I seek a state of mind that permits me to accept the darkness as well as the light. Through my practice, I have learned how to rest in them both.

Amy Weintraub is a fiction writer and editor who teaches yoga and writing in Tucson, Arizona. She also edits books on spiritual psychology and yoga.